Ethics – Charité

Persons and functions

The department for and , CCM, has a working group “ of Psychiatry, and Medical ”, led by assistant professor Dr. Sabine Müller and Prof. Dr. Dr. Henrik Walter. (https://mindandbrain.charite.de/projekte/neurophilosophie_und_ethik/medizinethik/).

Dr. Sabine Müller has a PhD in philosophy and her habilitation is for neurophilosophy and medical ethics. She is member of the “Akademie für Ethik in der Medizin e. V.” (AEM), and coleader of the “AG Neuroethics” in the AEM. She is member of the Clinical Ethics Committee (KEK) of the Charité in formation. Furthermore, she is member of several working groups dealing with ethical and legal aspects of psychiatry: “AG Ethics in Psychiatry” in the AEM, “AG Human Rights” of the “Aktion Psychisch Kranke e.V.”, “Commission for Ethics and Law in Psychiatry and Psychotherapy” of the DGPPN, and “AG Suicide Assistance” of the DGPPN. Sabine Müller has led two third-party funded projects in neuroethics (DFG: MU 3321 1-1; BMBF: 01 GP 1621A). She was coordinator of the international consortium “Psychiatric neurosurgery – ethical, legal and societal issues”, ERA-NET NEURON, BMBF).

Prof. Dr. Dr. Henrik Walter has, besides his MD, a PhD in philosophy. He served as Head of the Taskforce “Ethics in Psychiatry” of the DGPPN (2013-2015) and as Head of the “Ethical Research Committee of the European Brain Project” (2014-2018). Furthermore, he is member of the Ethics Committee of the Charité. He was coordinator of the international consortium “NeuroSCAN – Ethical and legal aspects of norms in ” (BMBF: 01 GP 0804).

Prof. Dr. Surjo Soekadar is PI in the international consortium “Hybrid Minds: Experiential, ethical and legal investigation of intelligent neuroprostheses” (ERA-NET NEURON).

Prof. Dr. Dr. Andreas Heinz is member of the “Commission for Ethics and Law in Psychiatry and Psychotherapy” of the DGPPN and of the “AG Suicide Assistance” of the DGPPN.

Prof. Dr. Christine Heim is member of the Ethics Committee of the Charité.

Dr. Ulrike Lüken is member of the Ethics Committee of the Medical Faculty of the TU Dresden.

Prof. Dr. Meryam Schouler-Ocak is member of the Ethics Committee of the European Psychiatric Association (EPA).

Further activities

Prof. Dr. Felix Bermpohl is co-coordinating the Winter School “Ethics and Neuroscience” of the BCCN Berlin/ICCN and the Berlin School of Mind and Brain since now 10 years.

PD Dr. Sabine Müller regularly gives lectures and seminars at the Charité on medical ethics, and supervises several PhD students working in this field.

Ethical research projects and ethical research support

Research topics of the working group “Philosophy of Psychiatry, Neurophilosophy and Medical Ethics” are ethical issues of interventions into the brain (e.g., deep brain stimulation, ablative psychiatric neurosurgery, epilepsy surgery, radiosurgery, and optogenetics), ethical and legal issues of the treatment of autoimmune encephalitis and mild encephalitis, neuroenhancement, patients’ autonomy, stigmatization of people with mental disorders, ethical and legal issues of compulsory treatments, ethical and legal issues of neuroimaging, , neurolaw, children’s rights in medicine, ethics of psychotherapy, and conceptual issues of psychiatry.

Besides ethical research topics, the empirical research is supported by team members with ethical competence. Of particular relevance are currently questions of data protection, data safety, data sharing, and the possibility to intensively survey the behavior of study participants. These issues are particularly relevant in smartphone-based prevention and intervention projects.

Furthermore, privacy issues are especially crucial in international projects with large scale prospective cohorts from several countries that assess the developmental trajectory of mental disorders. International cooperation is important to transfer research findings to different social and cultural contexts. However, data sharing across different national health care systems requires a careful consideration of different ethical and legal standards in research, data protection, data safety, patient care, respect for the rights of patients and study participants. For our cooperation with China, we have discussed ethical, legal and practical challenges with a focus on research participants in a recent publication (Liu et al. 2020). Our aim is to promote international cooperation by facilitating an exchange in relation to legal and practical approaches.

Selected publications in medical ethics and neuroethics

Bach Q, Thomale U-W, Müller S: Parents’ and children’s decision-making and in pediatric epilepsy surgery. Epilepsy & Behavior 2020, 107:107078 Bittlinger M, Müller S: Opening the debate on deep brain stimulation for Alzheimer disease – a critical evaluation of rationale, shortcomings, and ethical justification. BMC Medical Ethics 2018, 19(41): 1-23 Cabrera LY, Bittlinger M, Lou H, Müller S, Illes J: Reader comments to media reports on psychiatric neurosurgery: past history casts shadows on the future. Acta Neurochirurgica 2018, 160(12): 2501- 2507 Cabrera LY, Bittlinger M, Lou H, Müller S, Illes J: The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage. Acta Neurochirurgica 2018, 160(3): 625-635 Cabrera LY, Courchesne C, Bittlinger M, Müller S, Martínez-Álvarez R, Racine E, Illes J: Authentic self and last resort: international perceptions of psychiatric neurosurgery. Culture, Medicine, and Psychiatry 2020 Caulfield T, Rachul C, Zarzeczny A, Walter H: Sensationalizing Scanning? Mapping the Coverage of Neuroimaging Research. Scripted 2010, 7(3): 421-428 Christen M, Biller-Andorno N, Bringedal B, Grimes K, Savulescu J, Walter H: Ethical Challenges of simulation-driven big neuroscience. American Journal of Bioethics Neuroscience 2016, 7(1): 5-17 Christen M, Bittlinger M, Walter H, Brugger P, Müller S: Dealing with side effects of Deep Brain Stimulation: Lessons learned from stimulating the STN. American Journal of Bioethics Neuroscience 2012, 3(1): 37-43 Christen M, Domingo-Ferrer J, Draganski B, Spranger T, Walter H: On the compatibility of Big Data driven research and informed consent based on traditional disease categories – the example of the Human Brain Project. In: Floridi & Mittelstadt: Ethics of Biomedical Big Data. Springer, 2015, pp. 199- 218. Christen M, Ineichen C, Bittlinger M, Bothe H-W, Müller S: Ethical focal points in the international practice of deep brain stimulation. American Journal of Bioethics Neuroscience 2014, 5(4): 65-80 Christen M, Müller S: Single cases promote transfer in the field of DBS. Frontiers in Integrative Neuroscience 2011, 5, Article 13 Christen M, Müller S: The clinical and ethical practice of neuromodulation ‒ Deep brain stimulation and beyond. Frontiers Research Topics Ebook 2017 Gerlinger G, Deister A, Heinz A, Koller M, Müller S, Steinert T, Pollmächer T: Nach der Reform ist vor der Reform: Ergebnisse der Novellierungsprozesse der Psychisch-Kranken-Hilfe-Gesetze der Bundesländer. Der Nervenarzt 2019, 90(1):45-57 Guillen Gonzalez D, Bittlinger M, Erk S, Müller S: Neuroscientific and genetic evidence in criminal cases: a double-edged sword in Germany but not in the United States? Frontiers in Psychology 2019, 10, Art. 2343, 1-14 Heinz A, Müller S, Wackernagel C, Sartorius N: Inclusion as the goal of treatment – Therapeutic aims in light of the UN Convention on the Rights of Persons with Disability. Ethics, Medicine & Public Health 2015, 1: 300-305 Liu S, Müller S, Dolan RJ, Zhao X, Zheng JC, Heinz A: Opportunities, risks and challenges in global mental health and population neuroscience: a case of Sino-German cooperation. European Archives of Psychiatry and 2020 Müller S: Einfluss der UN-Behindertenrechtskonvention auf die deutsche Rechtsprechung und Gesetzgebung zu Zwangsmaßnahmen. Fortschritte der Neurologie – Psychiatrie 2018, 86: 485-492 Müller S: Gute Gründe für Odysseus-Verfügungen. Ethik in der Medizin 2016, 28(3): 255-258 Müller S: Moral Enhancement durch Neurochirurgie? Machbarkeit und ethische Vertretbarkeit. Ethik in der Medizin 2018, 30(1): 39-56 Müller S: Personality and Autonomy in Light of Neuroscience. Ethical and Neurophilosophical Issues of Interventions in the Brain. Kumulative Habilitationsschrift, Freie Universität Berlin, Charité – Universitätsmedizin Berlin, 2014, http://www.diss.fu- berlin.de/diss/receive/FUDISS_thesis_000000097489 Müller S: Respect for autonomy in light of . Bioethics 2017, 31(5): 360-367 Müller S, Bittlinger M, Brukamp K, Christen M, Friedrich O, Gruber M-C, Leefmann J, Merkel G, Nagel SK, Stier M, Jox RJ: Neuroethik ‒ Geschichte, Definition und Gegenstandsbereich eines neuen Wissenschaftsgebiets. Ethik in der Medizin 2018, 30(2): 91-106 Müller S, Bittlinger M, Walter H: Threats to neurosurgical patients posed by the personal identity debate. Neuroethics 2017, 10: 299-310 Müller S, Christen M: Deep Brain Stimulation in Parkinsonian patients – Ethical evaluation of stimulation-induced personality alterations. American Journal of Bioethics Neuroscience 2011, 2(1): 3-13 Müller S, Heinz A: Stigmatisierung oder Entstigmatisierung durch Biologisierung psychischer Krank- heiten? Nervenheilkunde 2013, 12: 955-961 Müller S, Riedmüller R: How the mild encephalitis hypothesis of schizophrenia influence stigmatization? Frontiers in Psychiatry 2017, 8, Article 67 Müller S, Riedmüller R, van Oosterhout A: Rivaling in psychiatric neurosurgery: adjustability versus quick fix versus minimal-invasiveness. Frontiers of Integrative Neuroscience 2015, 9, Article 27 Müller S, Riedmüller R, Walter H, Christen M: An ethical evaluation of stereotactic neurosurgery for . American Journal of Bioethics Neuroscience 2015, 6(4): 50-65 Müller S, Walter H, Christen M: When benefitting a patient increases the risk for harm for third persons – the case of treating pedophilic Parkinsonian patients with deep brain stimulation. International Journal of Law and Psychiatry 2014, 37(3): 295-303 Müller S, Walter H, Heinz A: Zwangsbehandlungen bei psychisch Kranken: Fixieren statt behandeln? Deutsches Ärzteblatt 2012, 109(5): A-198/B-174/ C-174 Müller S, Walter H, Kunze H, Konrad N, Heinz A: Zwangsbehandlungen unter Rechtsunsicherheit. Teil 1: Die aktuelle Rechtslage zu Zwangsbehandlungen einwilligungsunfähiger Patienten mit psychischen Erkrankungen. Der Nervenarzt 2012, 83 (9): 1142–1149 Müller S, Walter H, Kunze H, Konrad N, Heinz A: Zwangsbehandlungen unter Rechtsunsicherheit. Teil 2: Folgen der Rechtsunsicherheit in der klinischen Praxis – Vorschläge zur Verbesserung. Der Nervenarzt 2012, 83 (9): 1150–1155 Münch R, Walter H, Müller S: Should behavior harmful to others be a sufficient criterion of mental disorders? Conceptual problems of the diagnoses of antisocial personality disorder and pedophilic disorder. Frontiers in Psychiatry 2020 Pollak T, Lennox B, Müller S, Benros M, Prüß H, Tebartz van Elst L, Klein H, Steiner J, Frodl T, Bogerts B, Tian L, Groc L, Hasan A, Baune B, Endres D, Haroon E, Yolken R, Benedetti F, Halaris A, Meyer J, Stassen H, Leboyer M, Fuchs D, Otto M, Brown D, Vincent A, Najjar S, Bechter K: An international consensus on an approach to the diagnosis and management of of suspected autoimmune origin: the of autoimmune psychosis. Lancet Psychiatry 2019, 7(1): 93-108 Prüß H, Köhler S, Müller S: Autoimmune Enzephalitiden – Diagnostischer und therapeutischer Entscheidungsbaum. Vorgehensweise bei fehlender Einwilligungsfähigkeit und Zulässigkeit von Zwangsbehandlungen. Der Nervenarzt 2020, 91(2): 122-130 Racine É, Dubljevic V, Jox RJ, Baertschi B, Christensen JF, Farisco M, Jotterand F, Kahane G, Müller S: Can neuroscience contribute to practical ethics? A critical review and discussion of the methodo- logical and translational challenges of the neuroscience of ethics. Bioethics 2017, 31(5): 328-337 Riedmüller R, Müller S: Ethical issues of the mild encephalitis hypothesis of schizophrenia. Frontiers in Psychiatry 2017, 8, Article 38 Salles A, Bjaalie JG, Evers K, Farisco M, Fothergill BT, Guerrero M, Maslen H, Muller J, Prescott T, Stahl BC, Walter H, Zilles K, Amunts K. The Human Brain Project: Responsible brain research for the benefit of society. Neuron 2019; 101(3):380-384 Schleim S, Spranger T, Walter H (eds.): Von der Neuroethik zum Neurorecht? Der Beginn einer neuen Debatte. Vandenhoeck & Ruprecht, 2009 Vollmann J, Walter H, Barnikol UB, Finzen A, Gather J, Gerlinger G, Heberlein A, Heinz A, Helmchen H, Lieb K, Maier W, Müller JL, Müller S, Pollmächer T, Saß H, Schramme T, Seidel M: Achtung der Selbstbestimmung und Anwendung von Zwang bei der Behandlung psychisch kranker Menschen. Eine ethische Stellungnahme der DGPPN. Der Nervenarzt 2014 85(11): 1419-1431 Wagner U, Walter H: Neuroscientific approaches to ‘mens rea’ assessment. In Krueger F, Grafman J (eds.) Human Beliefs. Contemporary Approaches to Cognitive Neuroscience Series. Psychology Press, 2012, 137-158 Walter H, Müller S: Neuroethik und Psychotherapie. In: Schiepek G. (ed.) Neurobiologie der Psychotherapie. Stuttgart, New York: Schattauer, 2. ergänzte Auflage, 2011, pp. 646-655 Walter H, Müller S: Optogenetics as a New Therapeutic Tool in Medicine? A View from the Principles of Biomedical Ethics. In: Hegemann P, Siegrist S (eds.) Optogenetics. De Gruyter, 2013, pp. 201-212 Wasserman D, Heinz A, Müller S: EPA Comments on Special Rapporteur on Torture. The Nordic 2013, 2: 29-30 Wißmann H, Peters M, Müller S: Physical or psychological child abuse and neglect: experiences, reporting behavior and positions toward mandatory reporting of pediatricians in Berlin, Germany. Child Abuse & Neglect 2019, 98: 1-12